title: Use of mental health telemetry to enhance identification and predictive value of early changes during augmentation treatment of major depression.
abstract: Standard clinical trial methodology in depression does not allow for careful examination of early changes in symptom intensity. The purpose of this study was to use daily "Mental Health Telemetry" (MHT) to prospectively record change in depressive and anxiety symptoms for depressed patients receiving augmentation treatment, and determine the extent and predictive capacity of early changes. We report results of a 6-week, open-label study of the addition of quetiapine XR (range, 50-300 mg) for adult patients (n = 26) with major depressive disorder who were nonresponsive to antidepressant treatment. In addition to regular study visits, all participants completed daily, wirelessly transmitted self-report ratings of symptoms on a Smartphone. Daily and 3-day moving average mean scores were calculated, and associations between early symptom change and eventual response to treatment were determined. Improvement in depressive and anxiety symptoms was identified as early as day 1 of treatment. Of the total decline in depression severity over 6 weeks, 9% was present at day 1, 28% at day 2, 39% at days 3 and 4, 65% at day 7, and 80% at day 10. Self-report rating of early improvement (≥20%) in depressive symptoms at day 7 significantly predicted responder status at week 6 (P = 0.03). Clinician-rated depressive and anxiety symptoms only became significantly associated with responder status at day 14. In conclusion, very early changes in depressive symptoms were identified using MHT, early changes accounted for most of total change, and MHT-recorded improvement as early as day 7 significantly predicted response to treatment at study end point.
authors.affiliation: From the *Department of Psychiatry, Sunnybrook Health Sciences Centre; †Department of Psychiatry, University of Toronto; and ‡Centre for Mobile Computing in Mental Health, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Ayal
authors.initials: A
authors.lastname: Schaffer
authors.forename: David
authors.initials: D
authors.lastname: Kreindler
authors.forename: Catherine
authors.initials: C
authors.lastname: Reis
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Levitt
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000069348:Quetiapine Fumarate; D012720:Severity of Illness Index; D013686:Telemetry / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate